Mantle cell lymphoma is a cancer that often responds well to initial treatment. Because of this, doctors often recommend intense treatment soon after diagnosis. While it is often successful, sometimes the cancer resists treatment or relapses. If it does, doctors will recommend immunotherapies. Chimeric antigen receptor cell therapy (CAR-T) and BTK inhibitor therapy are both used for resistant or relapsed mantle cell lymphoma.
About Mantle Cell Lymphoma
Mantle cell lymphoma is a form of non-Hodgkin’s lymphoma, meaning that it begins in the lymphatic system. It develops from lymphocytes within an area of the lymph nodes known as the mantle zone. Errors occur in the production or transformation of lymphocytes, resulting in malignant cells, which grow and multiply out of control.
The exact cause of this cancer is unknown, but doctors suspect that a gene mutation responsible for the release of the protein cyclin D1 plays a role. This protein plays a very important role in cell growth. If this protein is over produced and affects the B-cells, it can result in the characteristic symptoms of mantle cell lymphoma.
Symptoms of this cancer will not be noticeable in the early stages of the disease. Those affected typically realize that there is a problem when the lymph nodes in the neck, throat, elbows, shoulders, and chest swell. As the cancer progresses, symptoms may include a lack of appetite, a sense of fullness, nausea, vomiting, indigestion, bloating, heart burn, recurrent fevers, weight loss, pressure and pain from the lower back through the legs, and bowel issues. If the cancer spreads into the brain or spinal cord, people may experience headaches, dizziness, poor balance, confusion, irritability, and personality changes.
Medical professionals will conduct a physical exam to evaluate the lymph nodes, ask about family and medical history, and conduct several tests in order to diagnose this cancer. Tests include blood tests, biopsies of the lymph nodes, CT and PET scans, and colonoscopies to stage the cancer.
If the cancer is indolent, doctors may hold off on immediate treatment. Mantle cell lymphoma typically reacts well to initial treatment, which consists of a combination of chemotherapy, targeted therapy, stem cell transplants, and immunotherapy. New treatments are being studied as well, and clinical trials may be available for some patients.
Immunotherapies are typically used if mantle cell lymphoma does not respond to initial treatment or relapses. CAR-T therapy and BTK inhibitor therapy have both been shown to produce positive results for those who experience resistant or relapsed lymphoma.
Different forms of CAR-T therapy have shown very impressive results, with 70-90% response rates and 50-60% complete response rates. They are some of the only medications that have been able to effectively treat people with relapsed or refractory mantle cell lymphoma.
Multiple studies have been conducted to evaluate the effects of CAR-T therapy on those with refractory mantle cell lymphoma, proving that it is an effective treatment for those who have seen other therapies fail. This success makes medical professionals wonder if this therapy can have the same success with other diseases, such as central nervous system conditions or other lymphomas.
BTK inhibitors are also being used in the treatment of those with mantle cell lymphoma. Forms of this therapy are Calquence and Brukinsa. Doctors have found that these treatments are not as successful as CAR-T therapies, as patients often relapse after one or two years.
While not all patients experience success with immunotherapies, they have still provided positive results in those who have gone through multiple rounds of failed treatment in the past. Research is being conducted to improve these therapies, and medical professionals hope that they will continue to help those with mantle cell lymphoma and possibly those with other conditions.
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